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    <title>Title</title>
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<script type="text/javascript">

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            + "<div style='display: flex; align-items: center; justify-content: center; font-size: 3px;'>"
            + "<div style='width: 780px;'>"
            + "<div style='text-align: center;'><h2>亳州市城乡职工医疗保险费用结算单(住院)</h2></div>"
            + "<div>"

            + "<table cellspacing='0' width='780' style='border: none; text-align: left; table-layout:fixed; word-wrap:break-word;'>"
            // row 1 start
            + "<tr>"
            + "<td colspan='2'>住院类别:</td>"
            + "<td colspan='2'>预留</td>"
            + "<td colspan='2'>住院次数:</td>"
            + "<td colspan='2'>NO:</td>"
            + "</tr>"
            // row 1 end
            + "</table>"
            + "<table border='1' cellspacing='0' width='780' style='text-align: left; table-layout:fixed; word-wrap:break-word;'>"
            // row 1 start
            + "<tr>"
            + "<td colspan='2'>姓名:</td>"
            + "<td>性别:</td>"
            + "<td style='border-right: none;'>年龄:</td>"
            + "<td colspan='2' style='border-left: none;'>人员类别:</td>"
            + "<td colspan='2'>银行账号:</td>"
            + "</tr>"
            // row 1 end
            // row 2 start
            + "<tr>"
            + "<td colspan='3'>是否贫困人口:</td>"
            + "<td colspan='3'>是否两病人员:</td>"
            + "<td colspan='2'>人员属性:</td>"
            + "</tr>"
            // row 2 end
            // row 3 start
            + "<tr>"
            + "<td colspan='4'>入院时间:</td>"
            + "<td colspan='4'>出院时间:</td>"
            + "</tr>"
            // row 3 end
            // row 4 start
            + "<tr>"
            + "<td colspan='2' style='border-right: none;'>定点编号:</td>"
            + "<td colspan='4' style='border-left: none;'>定点名称:</td>"
            + "<td colspan='2'>异地就诊流水号:</td>"
            + "</tr>"
            // row 4 end
            // row 5 start
            + "<tr>"
            + "<td colspan='4'>单位:</td>"
            + "<td colspan='4'>病种:</td>"
            + "</tr>"
            // row 5 end
            // row 6 start
            + "<tr>"
            + "<td colspan='4'>发生金额:</td>"
            + "<td colspan='2'>扣款金额:</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 6 end
            // row 7 start
            + "<tr>"
            + "<td colspan='4'>医保目录费用(0):</td>"
            + "<td colspan='4'>乙类药(0.1):</td>"
            + "</tr>"
            // row 7 end
            // row 8 start
            + "<tr>"
            + "<td colspan='4'>特殊检查治疗(0.2):</td>"
            + "<td colspan='2'>材料费(0.1):</td>"
            + "<td colspan='2'>材料费(0.2):</td>"
            + "</tr>"
            // row 8 end
            // row 9 start
            + "<tr>"
            + "<td colspan='4'>其他:</td>"
            + "<td colspan='4'>乙类药(0.3):</td>"
            + "</tr>"
            // row 9 end
            // row 10 start
            + "<tr>"
            + "<td colspan='4'>本次一般费用:</td>"
            + "<td colspan='4'>限额累计:</td>"
            + "</tr>"
            // row 10 end
            // row 11 start
            + "<tr>"
            + "<td colspan='2'>基本医保支出:</td>"
            + "<td colspan='2'>基本医保自付:</td>"
            + "<td colspan='2'>职工医保支出:</td>"
            + "<td colspan='2'>职工医保自付:</td>"
            + "</tr>"
            // row 11 end
            // row 12 start
            + "<tr>"
            + "<td colspan='4'>进入民政救助金额:</td>"
            + "<td colspan='4'>民政救助支付金额:</td>"
            + "</tr>"
            // row 12 end
            // row 13 start
            + "<tr>"
            + "<td colspan='4'>进入财政兜底金额:</td>"
            + "<td colspan='4'>财政兜底支付金额:</td>"
            + "</tr>"
            // row 13 end
            // row 14 start
            + "<tr>"
            + "<td colspan='4'>进入180补偿金额:</td>"
            + "<td colspan='4'>180补偿支付金额:</td>"
            + "</tr>"
            // row 14 end
            // row 15 start
            + "<tr>"
            + "<td colspan='4'>进入大病保险费用:</td>"
            + "<td colspan='4'>大病保险支付金额:</td>"
            + "</tr>"
            // row 15 end
            // row 16 start
            + "<tr>"
            + "<td colspan='2' style='border-right: none;'>上次个人账户余:</td>"
            + "<td colspan='2' style='border-left: none;'>本次个人账户支付:</td>"
            + "<td colspan='2' style='border-right: none;'>本次个人账户余:</td>"
            + "<td colspan='2' style='border-left: none;'>公务员补助支付:</td>"
            + "</tr>"
            // row 16 end
            // row 17 start
            + "<tr style='text-align: right;'>"
            + "<td colspan='8'>个人负担: 260  (其中起付线: 0+费用段自付: 0+其他: 0-公务员补助支付: 0-大病保险支付: 0)</td>"
            + "</tr>"
            // row 17 end
            // row 18 start
            + "<tr>"
            + "<td colspan='4'>实报金额: (大写):</td>"
            + "<td colspan='4'>¥:(小写)</td>"
            + "</tr>"
            // row 18 end
            // row 19 start
            + "<tr>"
            + "<td colspan='2' style='border-right: none;'>医疗费用初审:</td>"
            + "<td colspan='2' style='border-left: none; border-right: none;'>财务支付:</td>"
            + "<td colspan='2' style='border-left: none; border-right: none;'>财务支付:</td>"
            + "<td colspan='2' style='border-left: none;'>&emsp;&emsp;&emsp;年&emsp;&emsp;月&emsp;&emsp;日</td>"
            + "</tr>"
            // row 19 end
            + "</table>"
            + "</div>"
            + "</div>"
            + "</div>";
        $("#bd").empty().html(htmlStr);
        let htmlStr1 = ""
            + "<div style='display: flex; align-items: center; justify-content: center;'>"
            + "<div style='width: 780px;'>"
            + "<div style='text-align: center;'><h2>亳州市城乡职工医疗保险费用结算单(门诊)</h2></div>"
            + "<div>"

            + "<table cellspacing='0' width='780' style='border: none; text-align: left; table-layout:fixed; word-wrap:break-word;'>"
            // row 1 start
            + "<tr>"
            + "<td colspan='2'>住院类别:</td>"
            + "<td colspan='2'>预留</td>"
            + "<td colspan='2'>住院次数:</td>"
            + "<td colspan='2'>NO:</td>"
            + "</tr>"
            // row 1 end
            + "</table>"
            + "<table border='1' cellspacing='0' width='780' style='text-align: left; table-layout:fixed; word-wrap:break-word;'>"
            // row 1 start
            + "<tr>"
            + "<td colspan='2'>姓名:</td>"
            + "<td>性别:</td>"
            + "<td style='border-right: none;'>年龄:</td>"
            + "<td colspan='2' style='border-left: none;'>人员类别:</td>"
            + "<td colspan='2'>银行账号:</td>"
            + "</tr>"
            // row 1 end
            // row 2 start
            + "<tr>"
            + "<td colspan='3'>是否贫困人口:</td>"
            + "<td colspan='3'>是否两病人员:</td>"
            + "<td colspan='2'>人员属性:</td>"
            + "</tr>"
            // row 2 end
            // row 3 start
            + "<tr>"
            + "<td colspan='4'>入院时间:</td>"
            + "<td colspan='4'>出院时间:</td>"
            + "</tr>"
            // row 3 end
            // row 4 start
            + "<tr>"
            + "<td colspan='2' style='border-right: none;'>定点编号:</td>"
            + "<td colspan='4' style='border-left: none;'>定点名称:</td>"
            + "<td colspan='2'>异地就诊流水号:</td>"
            + "</tr>"
            // row 4 end
            // row 5 start
            + "<tr>"
            + "<td colspan='4'>单位:</td>"
            + "<td colspan='4'>病种:</td>"
            + "</tr>"
            // row 5 end
            // row 6 start
            + "<tr>"
            + "<td colspan='4'>发生金额:</td>"
            + "<td colspan='2'>扣款金额:</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 6 end
            // row 7 start
            + "<tr>"
            + "<td colspan='4'>医保目录费用(0):</td>"
            + "<td colspan='4'>乙类药(0.1):</td>"
            + "</tr>"
            // row 7 end
            // row 8 start
            + "<tr>"
            + "<td colspan='4'>特殊检查治疗(0.2):</td>"
            + "<td colspan='2'>材料费(0.1):</td>"
            + "<td colspan='2'>材料费(0.2):</td>"
            + "</tr>"
            // row 8 end
            // row 9 start
            + "<tr>"
            + "<td colspan='4'>其他:</td>"
            + "<td colspan='4'>乙类药(0.3):</td>"
            + "</tr>"
            // row 9 end
            // row 10 start
            + "<tr>"
            + "<td colspan='4'>本次一般费用:</td>"
            + "<td colspan='4'>限额累计:</td>"
            + "</tr>"
            // row 10 end
            // row 11 start
            + "<tr>"
            + "<td colspan='2'>基本医保支出:</td>"
            + "<td colspan='2'>基本医保自付:</td>"
            + "<td colspan='2'>职工医保支出:</td>"
            + "<td colspan='2'>职工医保自付:</td>"
            + "</tr>"
            // row 11 end
            // row 12 start
            + "<tr>"
            + "<td colspan='4'>进入民政救助金额:</td>"
            + "<td colspan='4'>民政救助支付金额:</td>"
            + "</tr>"
            // row 12 end
            // row 13 start
            + "<tr>"
            + "<td colspan='4'>进入财政兜底金额:</td>"
            + "<td colspan='4'>财政兜底支付金额:</td>"
            + "</tr>"
            // row 13 end
            // row 14 start
            + "<tr>"
            + "<td colspan='4'>进入180补偿金额:</td>"
            + "<td colspan='4'>180补偿支付金额:</td>"
            + "</tr>"
            // row 14 end
            // row 15 start
            + "<tr>"
            + "<td colspan='4'>进入大病保险费用:23232</td>"
            + "<td colspan='4'>大病保险支付金额:</td>"
            + "</tr>"
            // row 15 end
            // row 16 start
            + "<tr>"
            + "<td colspan='2' style='border-right: none;'>上次个人账户余:</td>"
            + "<td colspan='2' style='border-left: none;'>本次个人账户支付:</td>"
            + "<td colspan='2' style='border-right: none;'>本次个人账户余:</td>"
            + "<td colspan='2' style='border-left: none;'>公务员补助支付:</td>"
            + "</tr>"
            // row 16 end
            // row 17 start
            + "<tr style='text-align: right;'>"
            + "<td colspan='8'>个人负担: 260  (其中起付线: 0+费用段自付: 0+其他: 0-公务员补助支付: 0-大病保险支付: 0)</td>"
            + "</tr>"
            // row 17 end
            // row 18 start
            + "<tr>"
            + "<td colspan='4'>实报金额: (大写):</td>"
            + "<td colspan='4'>¥:(小写)</td>"
            + "</tr>"
            // row 18 end
            // row 19 start
            + "<tr>"
            + "<td colspan='2' style='border-right: none;'>医疗费用初审:</td>"
            + "<td colspan='2' style='border-left: none; border-right: none;'>财务支付:</td>"
            + "<td colspan='2' style='border-left: none; border-right: none;'>财务支付:</td>"
            + "<td colspan='2' style='border-left: none;'>&emsp;&emsp;&emsp;年&emsp;&emsp;月&emsp;&emsp;日</td>"
            + "</tr>"
            // row 19 end
            + "</table>"
            + "</div>"
            + "</div>"
            + "</div>";
        $("#bd1").empty().html(htmlStr1);
    })

</script>
</html>